This research project is in progress. PCORI will post the research findings on this page within 90 days after the results are final.
What is the research about?
Every 40 seconds, someone in the United States has a stroke. Stroke is a leading cause of long-term disability. About half of people who survive a stroke have weakness or some loss of movement in the arm and hand on one side of the body. Losing hand function can make tasks such as getting dressed and cooking harder.
Constraint-induced movement therapy, or CI therapy, combines arm and hand exercises with habit changes that increase use of the weaker arm for daily tasks. Studies have shown that CI therapy can help patients regain movement after a stroke. However, traditional CI therapy is costly, not covered by insurance, and takes place over many in-person visits. The research team created a video game version of CI therapy that is cheaper and easier for patients to use. This study compares video game CI therapy, traditional CI therapy, and traditional physical therapy. The research team is comparing how well each type of therapy works to improve hand function in people who had a stroke.
Who can this research help?
Patients who have had a stroke and their therapists can use information from this study to help choose a therapy to regain hand function.
What is the research team doing?
Researchers at four medical facilities across the United States are recruiting 224 adults ages 18 and older who had a stroke in the past six months. All patients have lost some ability to move their arm and hand on one side of the body. The research team is assigning patients by chance to one of four therapies:
- Traditional CI therapy: During 10 visits with a therapist at a clinic, patients receive 35 hours of traditional CI therapy, including 15 hours of active practice with the weaker hand and arm. Patients also learn to identify problems using the weaker arm for daily tasks and come up with solutions with their therapist.
- In-home video game CI therapy between in-person therapy visits: Patients play the CI video game for 15 hours. They also spend five hours in person with a therapist across four visits. The game system records how long patients play the game and shares this information with the therapist. Patients also wear a smart watch that tracks how often they use the weaker arm for daily tasks. The in-person meetings involve the same methods used in traditional CI therapy to increase use of the weaker arm for daily tasks.
- In-home video game CI therapy between in-person therapy visits with added video sessions: This therapy is the same as video game therapy but includes six video sessions with a therapist. Patients also have 10 in-person sessions with a therapist across eight hours. The sessions involve the same methods used in traditional CI therapy to increase use of the weaker arm for daily tasks.
- Traditional physical therapy: Patients have five hours of standard clinic-based therapy across four sessions. Therapists tailor care to patients’ specific needs and give them exercises to do at home. The sessions don’t focus specifically on use of the weaker arm for daily tasks. After six-months, patients get the video game CI therapy. They have a two-hour initial meeting with a therapist to learn about the video game and to learn methods to increase use of the weaker arm for daily tasks.
The research team is tracking how well patients can use the weaker arm and hand before starting therapy, immediately after therapy, and six months later.
A group of patients, caregivers, and therapists is providing input throughout the study.
Research methods at a glance
^Lynne Vonda Gauthier, PhD, was the original principal investigator on this project.